North Dakota Health Insurance Practice Test

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• What does the term 'reduced benefits' imply in the context of at work benefits?
• What does the cancellation provision state regarding pending claims?
• In health insurance, how can a policyholder appeal a denied claim?
• What is the maximum benefit from a loss claim according to the benefit of disability provision?
• Which right does the insurer have regarding the physical exam and autopsy provisions?
• What is the penalty for employers with 50 or more employees who do not offer health coverage?
• How is disability defined in insurance terms?
• What benefit does the SIS rider provide specifically during the benefit period?
• Which of the following is a requirement for Medigap policies in terms of commissions?
• How many full-time employees must a business have to qualify for the SHOP?
• What is the purpose of the Medical Reimbursement Benefit?
• How does the Residual Disability Benefit differ from Partial Disability Benefit?
• What is the primary purpose of the Comprehensive Health Association of North Dakota (CHAND)?
• How frequently must health insurance companies provide a notice of privacy practices?
• What is a deductible in health insurance?
• Medicare Part C is also known as what?
• What does Workers Compensation primarily provide?
• What does "short-term health insurance" primarily cover?
• Medicare is a federal program designed for which age group?
• What is the purpose of the cancellation provision?
• Why might insurance companies impose lifetime limits on benefits?
• What is comprehensive coverage in health insurance?
• What is the typical grace period length for health insurance premiums?
• What does the navigator program provide to individuals seeking health coverage?
• Which type of long-term care is characterized by 24/7 skilled nursing care?
• Which of the following is NOT typically included in a provider network?
• Who qualifies for Medicaid assistance?
• Which statement accurately defines the 30-day free look period in long term care insurance?
• What is required to reinstate a lapsed health insurance policy?
• What is the function of an impairment rider?
• What is the primary function of a third-party administrator (TPA)?
• What is the time frame in which written proof of loss must be submitted to the insurer?
• Which type of insurance specifically provides care for dental treatments?
• What happens to benefits if a policyholder's new job is more hazardous?
• Preventive care is usually designed to do what?
• What do at work benefits allow for an insured who has partially returned to work?
• What happens during the reinstatement period for sickness claims?
• How long is the free look period for Medigap insurance policies?
• Which of the following best describes 'Limited Coverage' in insurance?
• Which of the following is NOT a criterion for Medicare eligibility?
• What type of facilities are considered alternatives to hospital care?
• What is "community rating" in health insurance?
• What does the benefit schedule outline regarding patient payments?
• What is the definition of a "provider network" in health insurance?
• When submitting a claim, what must the insured provide to the insurer?
• What does prescription drug coverage typically cover?
• What is one of the 12 mandatory policy provisions concerning claims in health insurance?
• How does a fixed indemnity plan differ from traditional health insurance?
• What requirement was established for pre-existing conditions under the Affordable Care Act reforms of 2014?
• Which type of health insurance plan typically has lower premiums but higher deductibles?
• Which benefit covers medical treatment and rehab for work-related injuries?
• How can "urgent care" be defined in health services?
• Define "out-of-pocket maximum."
• How long must a notice of claim be given to the insurer after an occurrence?
• What type of benefits does the Social Insurance Supplements (SIS) rider provide?
• Medicare SELECT plans operate under what specific condition?
• What is necessary for a change of beneficiary if the designation is irrevocable?
• What is one advantage of group health insurance plans?
• Which benefit is typically included in a comprehensive health insurance policy that may not be found in limited policies?
• What type of care does Dental Expense Insurance cover?
• What type of coverage does vision care provide?
• Which of the following benefits can be covered by a limited policy?
• What does Medicare Part B NOT cover?
• What is a notice of claim?
• What does "preventive care" refer to in health insurance?
• In the context of group policy regulation, what is experience rating?
• In a pre-paid MEP, what is the term often used to describe patients?
• Who designates the Primary Health Care Provider (PHCP) in a health insurance plan?
• What is the purpose of a second surgical opinion in cost containment care?
• What is required of health insurance plans to avoid pre-existing condition exclusions?
• Health Savings Accounts (HSAs) are primarily designed for which type of health plan?
• What does UCR stand for in health insurance terms?
• How does the Relation of Earnings Provision affect premium refunds?
• Who is referred to as a "beneficiary" in health insurance terms?
• What characterizes comprehensive major medical insurance?
• What is specified dread or disease coverage designed to do?
• What does "guaranteed issue" imply in the context of health insurance?
• What is the primary focus of the Essential Health Benefits (EHB) requirement?
• What is the typical feature of group health insurance plans?
• What is the primary characteristic of a Preferred Provider Organization (PPO)?
• How does a Health Maintenance Organization (HMO) primarily operate?
• What is a Partial Disability Benefit?
• What is the purpose of inflation protection in long-term care policies?
• Which term describes the insurers' agreement to pay a coverage amount after the deductible is met?
• What kind of illnesses does specified dread or disease insurance generally cover?
• Which of the following is NOT a reform introduced by the Affordable Care Act?
• What is the main objective of the Affordable Care Act (ACA)?
• How long is the grace period for a monthly premium payment?
• Which scenario describes eligibility for a Health Savings Account (HSA)?
• Which of the following best describes independent living facilities?
• What does social security disability insurance provide for eligible individuals?
• Which of the following services would NOT typically be covered by a limited policy?
• How do state insurance departments contribute to consumer protection?
• What factors can influence health insurance enrollment periods?
• What type of insurance pays a flat dollar amount for each day an insured is hospitalized as an inpatient?
• What is the primary function of a rehab benefit?
• What does the term "premium" refer to in health insurance?
• Which of the following services would likely qualify as preventive care?
• What is the role of the cancellation provision for the insured?
• What is the purpose of a summary of benefits and coverage (SBC)?
• Blanket Insurance is best described as what type of policy?
• To whom are claims typically paid unless otherwise specified?
• What is a result of the income replacement provision?
• What does "network" refer to in health insurance?
• What characterizes an "exclusive provider organization" (EPO)?
• What does Essential Health Benefits (EHB) refer to?
• In the assignment of benefits provision, who receives the payment of medical benefits?
• What does a pre-paid medical expense plan typically require from the insured?
• In health insurance terminology, what are "exclusions"?
• How long does one have to file a legal action after proof of loss?
• Medicaid serves which of the following populations?
• How is "medically necessary" defined in health insurance claims?
• What is the role of the National Association of Insurance Commissioners (NAIC)?
• How long can partial disability benefits typically last?
• What is the insurer's responsibility after being notified of a loss?
• In the context of a health insurance plan, what does the terms 'in-network' mean?
• During which time frame does the benefit period for disability insurance policy apply?
• Group premium calculations consider which two primary factors?
• The insurance company’s contracted providers are part of which framework?
• In which jurisdiction are group policies typically regulated?
• What is the primary purpose of health insurance?
• What is the payment frequency for periodic claims as per time of payment of claims?
• If a preexisting condition is allowed to be excluded in Medigap, how long can it be excluded?
• What does COBRA stand for?
• How do insurers handle a loss claim when multiple insurers are involved?
• What occurs when the limits of a basic policy are reached?
• What is the maximum reinstatement time period for a health insurance policy due to nonpayment?
• What option does COBRA provide for individuals who leave their job?
• What does a subsidy in health insurance refer to?
• What is the main feature of a fee for service medical expense plan?
• What does supplemental major medical insurance provide?
• What is a Health Savings Account (HSA)?
• What is the main responsibility of state insurance departments?
• What qualifies an insured for presumptive disability benefits?
• Which statement about the AMB rider is true?
• What type of expenses must Health Savings Account (HSA) funds be used for to remain tax-free?
• Which insurance pays a monthly benefit equal to a loan payment during the insured's total disability?
• What is an example of a situation where urgent care might be utilized?
• Which is NOT an optional policy provision mentioned?
• What must a beneficiary receive when they apply for Medigap insurance?
• Which tier provides the highest coverage in the health insurance marketplace?
• What is the significance of the community rating rule in health insurance?
• What must US citizens and legal residents maintain according to the ACA law?
• When are lump sum claims supposed to be paid according to the time of payment of claims?
• What type of care does the ACA provide at no cost to policyholders?
• Which of the following is a national health insurance program covering the elderly?
• What does "no rescissions" mean in the context of health insurance policies?
• How does premium assistance work under the Affordable Care Act?
• What is a waiting period in the context of health insurance?
• What does the term "medigap" refer to in health insurance?
• In Group Health Insurance, who typically receives a master contract?
• Under the alcohol and drug provision, when is an insurer liable for losses?
• What is a claim in the context of health insurance?
• What is a key feature of Health Savings Accounts (HSAs)?
• What was the main intention behind the Affordable Care Act passed in 2010?
• Which statement best describes coinsurance?
• What happens if an insured has multiple forms of insurance of the same type with one company?
• When was the North Dakota Life and Health Insurance Guaranty Association created?
• How does a chronic illness typically affect health insurance premiums?
• What condition is typically excluded under an impairment rider?
• What is the primary role of a pharmacy benefit manager (PBM)?
• What does the Future Increase Option (FIO) rider allow an insured to do?
• What is the purpose of a Cost-of-Living Adjustment (COLA) rider?
• What is the main responsibility of an underwriter in health insurance?
• What does utilization management focus on in healthcare?
• What does the Incontestability Clause state?
• What is "adverse selection" in health insurance?
• What is one of the main purposes of disability income insurance?
• How are health insurance rates typically determined?
• What happens if an insured engages in an illegal act according to the illegal occupation provision?
• In the context of health insurance, what does it mean if a service is deemed "not medically necessary"?
• How does Group Health Insurance assess members for coverage?
• Which of the following is a requirement for insurance plans under the ACA?
• What is the primary financial strategy behind a High Deductible Health Plan (HDHP)?
• Which of the following is a common exclusion in insurance policies?
• What is the primary purpose of the Small Business Health Options Program (SHOP)?
• What is one responsibility of employers regarding health coverage for their employees?
• What aspect of the prospective insured does long-term care underwriting primarily focus on?
• Which of the following is a requirement of the Affordable Care Act?
• What does "balance billing" refer to?
• What do income replacement contracts do for insured individuals?
• Which of the following is NOT covered by Medicare Part D?
• What does the military suspense provision provide for insured individuals?
• What does the Relation of Earnings Provision allow an insurer to do?
• What type of conditions does urgent care focus on treating?
• Which of the following descriptions fits a High Deductible Health Plan (HDHP)?
• What is co-insurance?
• What does comprehensive major medical insurance typically involve?
• What is the purpose of preventive care in health insurance?
• What characterizes a "non-renewable" health insurance policy?
• What does COBRA allow former employees and their dependents to do?
• What is the purpose of a waiver of premium in health insurance?
• In the health insurance marketplace, what percentage of coverage does the Gold tier provide?
• What is the typical purpose of urgent care services?
• How are benefits typically administered in a prescription drug plan?
• Which of the following best describes co-payment?
• How long is the benefit period for short term disability insurance typically?
• What is a Preferred Provider Organization (PPO)?
• What do Qualified Health Plans need to guarantee according to ACA regulations?
• Which of the following is NOT typically covered under Individual Health Insurance?
• If an insured's disability results from an accident, how does insurance respond?
• What does Individual Health Insurance evaluate for coverage?
• Which of the following is NOT a method of cost containment care?
• What is the primary difference between a copayment and coinsurance in health insurance?
• Which of the following would NOT typically be advised by navigators?
• What is the elimination period in a disability insurance policy?
• What document types make up the 'Entire Contract' provision?
• What types of perils are covered by health insurance?
• When can legal action be taken against the insurer regarding a claim?
• Which of the following is NOT typically a feature of short term disability insurance?
• In health insurance, what does coinsurance mean?
• What is the consequence of misstatement of age if the insured is younger than stated?
• Medicare Supplement Insurance (Medigap) is primarily designed to cover costs not covered by which parts of Medicare?
• What is the outcome of the illegal occupation provision?
• Which of the following best describes a key feature of Medicaid?
• When is preventive care most beneficial for policyholders?
• What does "network adequacy" require from insurance plans?
• What can be considered a consequence of having a high deductible health plan?
• What does hospital/medical expense coverage primarily help with?
• Under OBRA, how long can coverage be extended if a former employee is disabled at the time of termination?
• What is required before Medicare covers skilled nursing facility care?
• Which of the following is classified as a limited health insurance policy?
• What must happen for a beneficiary change to be effective if it is revocable?
• What is a stop loss limit?
• What must a consumer do to qualify for an HSA?
• What are the two main types of health insurance plans?
• Which of the following describes diagnostic and preventive dental treatment?
• What is the role of the Guaranty Association in North Dakota?
• What characterizes long term disability insurance?
• Which insurance covers only accidents that occur off the job?
• What typically happens to the premium cost for longer benefit periods in a disability policy?
• What is the time frame for submitting proof of loss to the insurer?
• What does the term 'usual, customary, and reasonable' imply for insurance payments?
• What is a major benefit of Medicare Part B?
• How are contributions to a Health Savings Account (HSA) treated for tax purposes?
• What is the Additional Monthly Benefit (AMB) rider designed to do?
• What is meant by the term "pre-existing condition" in health insurance?
• For Medicare Long-Term Care, how many days of skilled care does Medicare cover 100%?
• What type of care is typically covered at no cost to policyholders in health insurance plans?
• Which type of dental treatment is primarily focused on restoration?
• What does the alcohol and drug provision specifically mention about narcotics?
• Tri-Care health insurance is intended for whom?
• How long does an insured have to notify the insurer after a loss has occurred?
• What does the term "physician care requirement" refer to in the context of disability insurance?
• Which term describes the optional provision related to inaccuracies in age declarations?
• What is the purpose of the "Rescission" clause in health insurance?
• What does "churning" refer to in the health insurance field?
• What does disability income insurance provide?
• What type of care does Medicare Part A specifically cover?
• In health insurance, what does the term "network" imply?
• Which of the following is typically true of preventive services in health insurance plans?
• Which of the following is an exclusion in health insurance policies?
• What must be included in a notice of privacy practices by health insurance providers?
• Which of the following is NOT a requirement for marketing regulations in long term care insurance?